IMAGES IN CLINICAL MEDICINE

ANTLER SIGN OF PULMONARY VENOUS HYPERTENSION

*Dr. Aditya Samitinjay Gade,¹

^*1 Post graduate, Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally

A 72-year-old man presented with gradually progressive breathlessness for the past 3 months. He did not have any history of chest pain, cough, wheeze, syncope, palpitations, pedal oedema or hemoptysis. He had a long history of smoking and alcohol consumption for more than 3 decades. Routine blood tests returned normal. The CXR-PA view is showing an ‘Antler’ Sign, which is the cephalisation of the left upper lobe pulmonary veins.,¹It is the earliest sign of pulmonary venous hypertension visible on chest x-ray. This sign is also called as ‘Hands Up’ sign or ‘Inverted Moustache’ sign. Antler Sign occurs due to elevation of Left Atrial Pressure above (normal range - 5- 10 mm of Hg) 10 to 15 mm of Hg., ^2,3 The most common causes of this being Left heart failure and mitral valvular disease. Antler sign also represents Grade 1 Pulmonary oedema, with the pulmonary capillary wedge pressure (PCWP) at 13 – 18 mm of Hg (Normal = 8 to 12 mm of Hg).⁴

References

1. Stag’s Antler Sign (Lungs) - https://radiopaedia.org/articles/stag s-antler-sign-lungs
2. Lacey GD, Morley S, Berman L. The Chest X-Ray, A Survival Guide. Saunders. (2008) ISBN:0702030465.
3. Goodman LR, Felson B. Felson's Principles of Chest Roentgenology. W.B. Saunders Company. (2007) ISBN:1416029230
4. Brant WE, Helms CA. Fundamentals of diagnostic radiology. Lippincott Williams & Wilkins. (2007) ISBN:0781761352.